On 29 June 1877, as much of south and south-western India were being ravaged by a terrible famine that would ultimately kill millions, a letter to the editor was published in The Illustrated London News.

The letter talked about the situation of irrigation in the Madras Presidency in great detail.

“... first let us observe that there are four districts at this time which ought to have been like the other 12, overwhelmed by this terrible calamity, but three of which are not only free from famine themselves, but are in the highest state of prosperity, having a large surplus to supply the other districts; and the fourth, though not entirely relieved from famine, yet has a very considerable supply of grain."

The reason for this, the letter writer said, were government irrigation works. “The three districts, Tanjore, Godavari and Kistnah, instead of adding five millions more to starve, are pouring into the starving districts hundreds of thousands of tonnes of food."

The letter went on to outline the situation of irrigation in this region of India, with detailed measurements of the lengths of canals, the value of agricultural produce and the urgent need for better and more public expenditure. Expenditure that would have saved lives.

“Had half a million more acres been irrigated in each of these districts, and had they been put in effective communication with the rest of India by steam boat canals... the famine would have been nothing comparatively."

There are two things remarkable about this letter to The Illustrated London News, besides the fact that it deals with issues of irrigation and food supply that are still germane a century and a half later.

The first is that it was written by a woman who had never travelled to India in her life. The second thing is that this woman—who effortlessly quotes statistics about Kurnool district—was Florence Nightingale.

For most of the last five decades of her life—she died in London in August 1910—Nightingale was fixated with the problem of sanitation and irrigation in India.

But then, Nightingale was a remarkable woman with several obsessions—statistics, spirituality, poverty—and a tremendous capacity for work, thought and writing.

Nightingale is perhaps most widely remembered as a pioneer of the nursing profession in general, and for her efforts during the Crimean War in particular.

Some months after Britain declared war on Russia in March 1854, journalist William Howard Russell sent despatches to London deploring the condition of wounded soldiers and lack of trained nursing staff. Under mounting public pressure, Sidney Herbert, the secretary of state for war, asked Nightingale, already well known as a teacher and organizer of nurses, to assemble a team and set sail as soon as possible.

Within the month, Nightingale landed in Scutari, across the Bosphorus from Istanbul, with a team of 38 nurses. She then proceeded to assert herself on affairs through a combination of overbearing authority, discipline, a tendency to bulldoze through opposition and ruthless use of her powerful contacts in London. She was not, by most accounts, anything like the delicate healing angel with the lamp.

By the end of the war, Nightingale was something of a national hero. She sailed back in 1856 and when she arrived, her entry in the Oxford Dictionary of National Biography says, she was “emaciated and tense, and weighed down with the burden she felt had been placed on her, she realized that if such suffering were never to happen again, the Army Medical Service, and, if necessary, the army itself, must be reformed".

“Nightingale’s efforts," I. Bernard Cohen wrote in a seminal 1984 Scientific American profile, “were not in vain. Four subcommissions were established... The first presided over physical alterations to military barracks and hospitals: improvements in ventilation, heating, sewage disposal, water supply and kitchens. Other subcommissions drafted a sanitary code for the army, established a military medical school and reorganised the army’s procedures for gathering medical statistics."

In 1858, Nightingale turned her gaze to the state of the British Army in India. Reports had emerged of the appalling conditions of troops who suffered from a death rate six times higher than those of civilians in England.

Through 1858 and 1859, Nightingale used her considerable influence in London’s circles of power to lobby the government into establishing a royal commission on the sanitary state of the army in India. This was, so to speak, a classic Nightingale move—she harangued the government into setting up a commission, which she then browbeat into action with relentless campaigning, statistics and her signature abrasive vigour.

To get a concrete sense of the situation in the colony, Nightingale sent out, with the commission’s blessings, 200 questionnaires on health and sanitation to each British station in India. It is testament to her tenacity that these forms were all filled in by three officers per station—commanding, engineering and medical—and found their way back to her in London.

Nightingale meticulously compiled all this data, augmented it with oral submissions from soldiers stationed in India, and then published a report in 1863. It was titled, with typical Victorian efficiency, Observations on the Evidence Contained in the Station Reports Submitted to Her by the Royal Commission of the Sanitary State of the Army in India by Florence Nightingale.

Nightingale later wrote, with more than a passing sense of self-congratulation, that “it was truly said that such a complete picture of life in India, both British and native, is contained in no other book in existence".

The report made Nightingale an authority on matters Indian. So much so that for some four decades afterwards, every freshly appointed Indian viceroy visited Nightingale at least once before sailing to India. Some of this encyclopaedic knowledge comes across in many of her writings, including that letter to The Illustrated London News.

The British government, however, was less than pleased with Nightingale’s meticulous analysis. While they did not censor it outright, efforts were made to ensure that her observations reached as few people as possible. When the government refused to publish copies, Nightingale printed and circulated them at her own expense.

The one statistic that emerged from these studies, and outraged the British public, was that 69 per 1,000 troops serving in India died each year. In an 1863 paper titled How People May Live and Not Die in India, published shortly after the Observations to great acclaim, Nightingale calculated that the British Army lost approximately 5,037 men a year.

Nightingale’s approach to assuaging this expensive and appalling loss of life appears to have been twofold. She used both scientific arguments and cultural ones.

In her Observations, she outlined five main reasons why British stations in India were so deadly—bad water, bad drainage, filthy bazaars, want of ventilation and surface overcrowding in barrack huts and sick wards.

In How People May Live and Not Die in India, on the other hand, Nightingale pointed her finger at the blissful British ignorance of life and conditions out in the empire. Why is the death rate so much higher in India than in Britain?

“I am afraid the reply must be that British civilisation is insular and local, and that it takes small account of how the world goes on out of its own island. There is a certain aptitude amongst other nations which enables them to adapt themselves, more or less, to foreign climates and countries. But, wherever you place your Briton, you may feel quite satisfied that he will care nothing about climates."

It is a scathing rebuke delivered in a tone that appears frequently in Nightingale’s condemnation of British policy in India.

The Observations go into great detail about the problems with stations and towns in India. Nightingale realized something peculiar about the situation of the British Army in India. While in Britain, soldiers in barracks tended to be less healthy than the residents of surrounding towns; in India, the situation was reversed. British soldiers were dying in large numbers, but they were still much healthier than the natives who lived in the squalid towns and cities.

Agra’s water, Nightingale found, is “laxative" and “apt to disagree at first". In Bangalore, the barracks drew their drinking water from Ulsoor tank, the same tank into which the local bazaar and the barracks themselves released most of their drainage.

“Madras and Wellington are literally the only stations where anything like lavatories and baths, with proper laying on of water and proper draining it off, is known, either in barrack or hospital."

Nightingale’s report not only had numerous such observations, but also woodcut illustrations of water carriers, scavengers and the architectural designs of barrack buildings. All these, again, commissioned at the author’s expense.

She summarized that India needed immediate sanitary reform. Every single town, she said, needed water supply, draining, paving, cleansing and “healthy plans for arranging and constructing buildings".

So far so good. By this point, the government in India and London realized Nightingale was going to be a problem. In India, the army wasn’t particularly keen on letting a nurse design their barracks for them. In London, there was increasingly little appetite for social spending in India.

But Nightingale wasn’t one to shrink away from a challenge. Over the next decade, she built a rapport with several local administrators in India and constantly pushed them to carry out reforms outlined in her reports and papers.

Viceroy by viceroy, medical by medical officer, Nightingale egged on sanitary reforms.

Ten years later, at the 1873 meeting of the National Association for the Promotion of Social Sciences in Norwich, Nightingale presented a paper titled Life or Death in India.

She announced that in the space of that decade, the death rate among British soldiers in India had dropped from 69 per 1,000 to around 18 per 1,000. This was good news, but she had a word of caution. “For it must not be assumed that the work of improvement is done. Far from it. The general result only indicates progress towards realisation, not realisation."

She picked the work done in Calcutta, Bombay and Madras to highlight this story of good but incomplete reform. Ten years earlier, she said, “Bombay had... a better water supply, but no drainage. Calcutta was being drained but had no water supply. Madras had neither."

But now, she wrote, Calcutta had its water supply complete. “All castes, use it: and find, indeed, the fabled virtues of the Ganges in the pure water tap." Improving Calcutta’s drainage was considered a hopeless venture, Nightingale wrote, but great work had been done. “Many miles of ditches have been filled up, to the great detriment of mosquitoes and great comfort of the inhabitants."

Thus the number of deaths from cholera in Calcutta had dropped from 7,000 in 1866 to 800 in 1871. “Calcutta in 1871 was more salubrious than Manchester or Liverpool, and may be considered soon a sanitarium compared with Vienna, or even with Berlin where the city canals are still fouled with sewage."

What about Bombay? Nightingale’s measure of the city rings true to this day. “Bombay has for years done everything to drain itself, except doing it... it has had surveys, plans, reports, paper and print enough to drain all India—writing and talking enough for a thousand years. The only thing it has not done is to do it."

And Madras?

“Madras has obtained a water supply, and has just improved it, and is applying part of her sewage to agriculture with success. In other respects she appears to be pretty much as she was, with her filthy Cooum estuary, and her foul, undrained area."

Some of the most striking results in the paper has to do with prison populations. In Cuddalore, Madura, Rajahmundry and Vellore, prisoners in new jails, or old jails with improved sanitation, all survived cholera epidemics better than local residents who lived outside the jail.

In some cases, every single prisoner survived. Even the foulest village with the worst death rates showed tremendous improvements when “wells were dug and properly protected; surface drainage was improved, rigid cleanliness enforced, trees planted..."

Nightingale goes on to make several important observations about sanitation reform in India. For instance, she wrote, government responses should be two-pronged. The government can spend, but it must also “let the people only see how much they can do for themselves in improving their surface drainage, in keeping their water supply free from pollution, in cleansing inside and out".

Additionally, while initiatives can be driven by the central government, it must “at the same time insist on the municipalities and local authorities prosecuting the good work".

Also key were good data and a reporting system, and trust between citizens and institutions that worked on public health.

And if these reforms are expensive, Nightingale wrote, then by all means raise taxes. “There is never any ‘discontent’ about this. What they do not like is paying the tax and receiving no water: and in this they are not so far wrong."

The first 10 years were a qualified success. There was little doubt that money spent shrewdly saved British and native lives. This work had to be continued, Nightingale wrote. “Thus it will be rendered not only an easy matter to hold the great Indian Empire by a British force, but benefits untold will be conferred on the vast populations of our fellow subjects of whom we have undertaken the charge."

Nightingale wrote this in 1873, at a time when her influence over India and policy in the country was, perhaps, at its pugnacious peak. By the early 1900s, it began to wane, and viceroys no longer deemed it necessary to seek her wisdom before they sailed for India.

And even if the India Office still sent her copies of papers and reports that had to do with sanitation, Nightingale slowly lost her ability to influence administrators and city managers in India with her letters, reports and statistics. Besides, the appetite for large spending on famine and irrigation reform in India was drying up in London

Before she died in 1910, according to one biographer, Nightingale asked that all her papers pertaining to India be preserved. She considered it some of her most important work.

Glancing through these documents and reports, it is remarkable to see how Florence Nightingale pinpointed the challenges with bringing sanitation and irrigation reforms to such a large and diverse country.

At the time, much more so than today, cleaning up India was seen by many administrators as an impossible task beset by bureaucratic, cultural, geographic, social and meteorological challenges. Nightingale had little time for such excuses. What had to be done, had to be done.

“There is no country in the world for which so much might be done as for India," she wrote in 1873. “There is not a country in the world for which there is so much hope. Only let us do it."

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